Prognistic significane of different prognostic scoring systems on angioimmunoblastic T-cell lymphoma
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摘要: 目的 探讨血管免疫母细胞性T细胞淋巴瘤(AITL)的临床特征和预后影响因素,比较几种预后分层模型对其预后的评估价值。方法 回顾性分析79例AITL患者的临床资料,采用国际预后指数(IPI)、外周T细胞淋巴瘤预后指数(PIT)、AITL预后指数(PIAI)评分及新建立的预后积分系统对患者进行危险分层。采用Kaplan-Meier法及Cox回归模型进行生存及预后分析,受试者工作特征(ROC)曲线比较不同预后积分系统的预测价值。结果 AITL患者的中位发病年龄为66(29~83)岁。可评估疗效的73例患者中,获得完全缓解27例(37.0%),部分缓解20例(27.4%),总体缓解率为64.4%。中位总生存期(OS)为17(1.0~107.0)个月,3年和5年生存率分别39.76%和26.51%,3年和5年无进展生存率分别为23.58%和17.33%。基于多因素分析不良预后因素为年龄＞65岁、ECOG评分＞1分、C-反应蛋白(CRP)＞20 mg/L和预后营养指数(PNI)＜44.35,建立一种新的预后积分系统,其在甄别低危及中低危、中高危及高危患者方面优于IPI、PIT、PIAI评分。在预测AITL患者OS和无进展生存期(PFS)的ROC曲线中,新预后积分系统的AUC分别为0.825 9(95%CI 0.715 7~0.936 1)和0.859 2(95%CI 0.751 3~0.967 0)。结论 AITL好发于高龄老年人,初诊时多为Ⅲ—Ⅳ期,疾病进展快,疗效及预后较差。与IPI、PIT及PIAI评分相比,基于年龄＞65岁、ECOG评分＞1分、CRP＞20 mg/L和PNI＜44.35所建立的新预后积分系统预后评估价值更高,更有助于识别高危患者。
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关键词:
- 淋巴瘤,T细胞性,血管免疫母细胞性 /
- 临床特征 /
- 生存率 /
- 预后模型 /
- 国际预后指数 /
- 外周T细胞淋巴瘤预后指数 /
- AITL预后指数
Abstract: Objective To explore the clinical characteristics and prognostic factors of angioimmunoblastic T-cell lymphoma (AITL) and to compare the prognostic value of several stratification models for evaluating its prognosis. Methods A total of 79 AITL patients were selected and their clinical data were collected for retrospective analysis. The patients were stratified into risk categories based on the International Prognostic Index (IPI), the Prognostic Index for Peripheral T-cell Lymphoma (PIT), the AITL Prognostic Index (PIAI), and a newly established prognostic scoring system. Survival and prognostic analyses were performed using the Kaplan-Meier method and Cox regression model. Receiver operating characteristic (ROC) curves were plotted to compare the predictive value of different prognostic scoring systems. Results The median age at onset was 66 years (29-83 years). Among the 73 evaluable patients, 27 (37.0%) achieved complete remission, 20 (27.4%) achieved partial remission, and the objective response rate was 64.4%. The median overall survival (OS) was 17 months (1.0-107.0 months), with 3-year and 5-year OS rates of 39.76% and 26.51%, respectively. The 3-year and 5-year progression-free survival (PFS) rates were 23.58% and 17.33%, respectively. Based on multivariate analysis, poor prognostic factors included age >65 years, ECOG score >1, C-reactive protein (CRP) >20 mg/L, and prognostic nutritional index (PNI) <44.35. The new prognostic scoring system was established, which performed better at distinguishing low, low to medium, medium to high and high risk patients than the IPI, PIT, and PIAI scores. The area under the curve (AUC) for the new prognostic scoring system was 0.825 9 (95% CI 0.715 7-0.936 1) for OS and 0.859 2 (95% CI 0.751 3-0.967 0) for PFS. Conclusions AITL predominantly affects advanced elderly patients, with most diagnosed at stage III-IV, and the disease progresses rapidly with poor treatment outcomes and prognosis. Compared with the IPI, PIT, and PIAI scores, the newly established prognostic scoring system, based on age >65 years, ECOG score >1, CRP >20 mg/L, and PNI <44.35, offers higher diagnostic accuracy and is better suited for identifying high-risk patients. -
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